🔗 Share this article

For a long time, jolting along the soggy dirt track to the medical facility, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and focused on stopping herself throwing up. She was in delivery, in agonizing discomfort after her uterine wall split, but was now being shaken violently in the ambulance that lurched across the uneven terrain of the road through the Chadian desert.

Most of the close to a million Sudanese people who ran to Chad since 2023, surviving precariously in this inhospitable environment, are women. They reside in remote settlements in the desert with insufficient supplies, few job opportunities and with treatment often a perilously remote away.

The medical center Mohammed needed was in Metche, another refugee camp more than two hours away.

“I repeatedly suffered from infections during my pregnancy and I had to go the health post multiple occasions – when I was there, the labour began. But I wasn’t able to give birth normally because my womb had given way,” says Mohammed. “I had to endure a long delay for the ambulance but all I remember was the pain; it was so unbearable I became delirious.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would be bereft of her offspring and descendant. But Mohammed was rushed straight into surgery when she arrived at the hospital and an critical surgical delivery rescued her and her son, Muwais.

Chad was known for the world’s second worst maternal mortality rate before the recent arrival of refugees, but the situations faced by the Sudanese expose further women in risk.

At the hospital, where they have assisted in the arrival of 824 babies in often critical situations this year, the doctors are able to help plenty, but it is what affects the women who are fail to get to the hospital that worries the staff.

In the couple of years since the internal conflict in Sudan erupted, 86% of the refugees who have arrived and stayed in Chad are mothers and kids. In total, about over a million Sudanese are being accommodated in the eastern part of the country, four hundred thousand of whom ran from the past violence in Darfur.

Chad has accepted the majority of the millions of people who have run from the war in Sudan; others have gone to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been displaced from their homes.

Many adult men have remained to be close to homes and land; some were murdered, captured or forced into fighting. Those of employable age soon depart from Chad’s barren settlements to look for jobs in the capital, N’Djamena, or elsewhere, in neighbouring Libya.

It means women are stranded, without the resources to feed the dependents left in their charge. To avoid overcrowding near the border, the Chadian government has moved individuals to less crowded encampments such as Metche with average populations of about fifty thousand, but in isolated regions with limited infrastructure and scarce prospects.

Metche has a hospital established by a medical aid organization, which started off as a few tents but has grown to feature an procedure area, but little else. There is a lack of jobs, families must journey for extended periods to find firewood, and each person must survive on about nine litres of water a day – well under the suggested amount.

This seclusion means hospitals are treating women with problems in their pregnancy when it is almost too late. There is only a sole emergency vehicle to serve the area between the Metche hospital and the medical tent near the Alacha encampment, where Mohammed is one of nearly 50,000 refugees. The medical team has encountered situations where women in extreme agony have had to remain overnight for the ambulance to reach them.

Imagine being nine months pregnant, in delivery, and journeying for a long time on a donkey-drawn vehicle to get to a medical facility

As well as being bumpy, the road traverses valleys that become inundated during the wet period, completely preventing travel.

A surgeon at the hospital in Metche said all the situations she encounters is an critical situation, with some women having to make long and difficult journeys to the hospital by foot or on a donkey.

“Imagine being nine months pregnant, in labour, and journeying for an extended time on a cart pulled by a donkey to get to a medical center. The primary issue is the delay but having to arrive under such circumstances also has an effect on the delivery,” says the surgeon.

Undernourishment, which is growing, also raises the chance of complications in pregnancy, including the womb tears that medical staff see regularly.

Mohammed has continued under care in the two months since her C-section. Suffering from malnutrition, she contracted an illness, while her son has been regularly checked. The father has travelled to other towns in seek jobs, so Mohammed is entirely leaning on her mother.

The malnutrition ward has increased to six tents and has patients spilling over into other sections. Children are placed under mosquito nets in oppressive temperatures in almost utter stillness as doctors and nurses work, preparing treatments and weighing children on a instrument created using a container and string.

In less severe situations children get packets of PlumpyNut, the specially formulated peanut paste, but the worst cases need a regular intake of fortified formula. Mohammed’s baby is administered his nutrition through a syringe.

Suhayba Abdullah Abubakar’s 11-month-old boy, Sufian Sulaiman, is being nourished via a nasal drip. The baby has been unwell for the past year but Abubakar was repeatedly given only painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see more children arriving in this tent,” she says. “The nutrition we receive is poor, there’s insufficient food and it’s lacking in nutrients.

“If we were at home, we could’ve coped better. You can go and cultivate plants, you can find employment, but here we’re dependent on what we’re distributed.”

And what they are provided is a meager portion of sorghum, vegetable oil and salt, handed out every couple of months. Such a simple food offers little sustenance, and the little cash she is given purchases very little in the weekly food markets, where prices have become inflated.

Abubakar was moved to Alacha after arriving from Sudan in 2023, having escaped the militia Rapid Support Forces’ assault on her birthplace of El Geneina in June that year.

Failing to secure jobs in Chad, her spouse has left for Libya in the desire to earning sufficient funds for them to come later. She lives with his kin, dividing up whatever meals they acquire.

Abubakar says she has already observed food distributions being reduced and there are worries that the abrupt cuts in international assistance funds by the US, UK and other European countries, could worsen the situation. Despite the war in Sudan having caused the 21st century’s worst humanitarian disaster and the {scale of needs|extent